Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME74032 | FL |
NPI | 1063423408 |
---|---|
Provider Name | Ahmed M Al-Malt |
First Address | Orlando, FL 32803-1456 |
Second Address | Orlando, FL 32803-1456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 27/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
253286700 | (05) | FL |
42268 | BLUE CROSS/SHIELD (01) | FL |
E54687 | (02) |